| NPI | 1972597078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 28654) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: MO 28654) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2008-01-07 |